What's new in endodontics?
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Biomedical subjects
Publications and source records attributed to F W Benenati.
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Cracked tooth syndrome typically poses a diagnostic challenge for the dentist. Symptoms include tenderness to biting on certain foods, often poorly localized, and occasional thermal sensitivity. Knowing where to look for this entity, especially in the mandibular molar region, can be especially helpful. Treatment of the tooth depends on the degree of pulpal involvement and the extent of the crack. Cuspal coverage is required of all cracked posterior teeth that are retainable. Root canal therapy is included if symptoms persist or if pulpal pathosis exists at the outset. Cracks extending beyond the osseous crest indicate a poor prognosis. Armed with this knowledge, the dentist can overcome many cracked tooth dilemmas, resulting in satisfaction for both patient and practitioner alike.
Sixty-one maxillary central incisors were collected, cleaned, and divided into six groups of 10 teeth, with one tooth as a control. Half of the teeth were resected with a high-speed bur and half with a slow-speed bur, and prepared for retrofillings. Retrofillings of EBA cement and Ketac cement were placed in 10 teeth, each of the high-speed and slow-speed groups. Similarly++, zinc containing amalgam was placed in 10 teeth of the high-speed group, and zinc-free amalgam was placed in 10 teeth in the slow-speed group. A single operator completed all retrofills. They were stored in physiological saline for 10 yr. After that period, the apical portions were photographed at X 30 magnification and evaluated by the authors for marginal discrepancies, root crazing, staining, voids, and roughness. Overall, EBA cement++ and amalgam rated better than Ketac cement in every category except root crazing. Perhaps, as some studies have suggested, EBA cement may replace amalgam as the retrofill material of choice.
The authors describe the case of a patient who had tenderness when biting and mild sensitivity to palpation as well as a radiopaque lesion attached to the mesial root of a mandibular first molar. Evidence pointed to a benign cementoblastoma. The dentist redid the original endodontic treatment and surgically removed the lesion, leaving the involved tooth intact. The authors suggest that in certain cases, it may be possible to remove benign cementoblastomas affecting molars without extracting the involved teeth.
Variations in the morphology of roots and root canal systems create challenges which the dental practitioner must be able to recognize. Endodontic therapy is predictable and successful only to the extent that the root canal system can be debrided, disinfected and sealed against future contamination. In order to accomplish these goals it is necessary to become familiar with the variability of the system we seek to treat.
Clinicians have often noted that aberrant root morphology in a given tooth is also observed with varying degrees of frequency in the corresponding contralateral tooth. The purpose of this study was to determine the proportion of bilateral morphological root aberrations in a random sample of adult human dentition. Five hundred one dental records were selected from the retired record section at the University of Oklahoma College of Dentistry and their full-mouth radiographs were reviewed for aberrant root canal morphology. Bifurcation of the canal in mandibular first premolars was the most common finding (22.8% of patients), with 60% of these being bilateral. Maxillary anterior teeth had the least aberrations. It was observed that unusual root morphology is bilateral approximately 60% of the time. Therefore, the incidence of root or root canal abnormalities reported by the percentage of patients involved will always exceed the incidence of abnormalities reported by type of tooth (e.g. mandibular or canine) involved except for abnormalities which are found bilaterally in 100% of the patients studied. Radiographic interpretation appears to result in a lower incidence of anatomical aberrations than direct identification. The more rare the aberration, the more likely it is to be bilateral in occurrence.
A case is reported involving nonsurgical and surgical treatment of a maxillary lateral incisor with a dens invaginatus and associated nonvital blunder-buss canal and a vital, normal-shaped canal. An attempt at apexification of the nonvital canal failed, resulting in the combined treatment modalities. A 1-year follow-up x-ray showed nearly complete periradicular osseous repair.
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Proper management of permanent incisors with horizontal root fractures includes careful diagnosis, continued re-evaluation and a conservative treatment approach. The location of the root fracture and pulpal vitality status both play important roles in proper treatment decisions. A thorough examination, judicious treatment and follow-up on the part of both dentist and patient can result in long term retention of many of these traumatized teeth.
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The authors provide a pictorial review of technical errors in endodontic instrumentation. Examples of separated instruments, abrupt constriction, laceration, canal transportation, and control zone errors are provided. The potential problems and effect on prognosis associated with these errors are explained.
A case is presented which involved resection of a sapphire endodontic stabilizer in a maxillary cuspid. This was necessary due to its perforation of the maxillary sinus. The implant was not readily identifiable upon viewing the preoperative radiograph and could only be resected using a diamond bur. Because of its limited degree of radiopacity, the use of sapphire as a material for endodontic stabilizers may be questioned from a diagnostic standpoint.
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